What kind of protection is important for travelers?


Doctors newspaper online, 15.04.2018

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travel medicine

No matter where the journey goes, the basic vaccines should be available. But even in 2018 there are special recommendations for some countries. Particularly important is the yellow fever vaccine.
By Anne Bäurle

Protection on holiday: When traveling to Brazil, the yellow fever vaccine is currently very important, for example. © Samc / stock.adobe.com

For travel medicine, there is still an intense indication of yellow fever vaccination: Since December last year, the case numbers have risen sharply again. Now, three German travelers have been infected, one of the tourists died, like that Robert Koch Institute announced recently. All three travelers were not vaccinated against yellow fever and have probably been infected on the island Ilha grande off Rio de Janeiro.
“The special thing about this yellow fever outbreak is that the coastal regions of Brazil are affected,” said Professor Tomas Jelinek from the Center for Travel Medicine CRM at the DGIM 2018 in Mannheim. These were until last year as yellow fever free. “We know that the circulating yellow fever virus carries eight point mutations, but whether these mutations are the reason the virus appeared on the shores, we do not know.”
Yellow fever danger in Brazil
The yellow fever vaccine is currently very important when traveling to Brazil, especially when traveling to areas that were previously considered yellow fever free. These included next to the Federal District, the states of Rio de Janeiro, Sao Paulo and Minas Gerais.
“Other countries, in which there are no cases of yellow fever, but in which very well the carrier mosquitoes are native, are nervous,” said the travel physician. Some countries therefore insisted on entry on a second yellow fever vaccine, even if a one-off is actually sufficient. “We therefore always recommend a second vaccination to avoid trouble.”
Meningococcal serotypes
A quite complex vaccination consultation is necessary for meningococci, reported Jelinek. Vaccination counseling depends on the age of the traveler, the global distribution of the serotypes and last but not least the different vaccines.
The extent to which the serotype distribution is changing is, according to Jelinek, a recent outbreak in Australia: “So far, the B serotype was considered to be the most common, but were at the current outbreak Most of MenW infections reported. “One would probably expect because of the high worldwide travel, that there will be soon all over the world all meningitis serotypes.
In Germany, two protein vaccines and five conjugate vaccines are currently approved. “In travel medicine, we can reduce this to one of two ACWY conjugate vaccines, Menveo® and Nimenrix®,” said Jelinek.
There is also a MenB vaccine, with the choice of vaccine depending on the age of the vaccine ends. “Trumenba® is only approved from the age of 10, but in principle has a better effect than Bexsero®, which is approved from the 2nd month of life.” The two vaccines are completely different, so you can not start with one vaccine and continue with the other.
An important change in the provision of advice to elderly and chronically ill travelers has resulted in the approval of the 13-valent pneumococcal conjugate vaccination for all ages. “Regrettably, the STIKO continues to prefer the polysaccharide vaccine,” says Jelinek. In travel medicine consultation, however, the benefits of conjugate vaccine could be highlighted.
For older travelers is also the new dead vaccine against herpes zoster relevant. The EMA recently launched the Shingrix® vaccine prevention approved by herpes zoster and post-zoster neuralgia in adults over 50 years. Jelinek said, “Shingrix® is expected to be available on the market in May.”
The travel medicine reminded because of the prolonged outbreaks of cholera in Yemen, Haiti and the Dominican Republic also a good vaccine against cholera. Dukoral® must be given up to 14 days before departure and also offers some protection against traveler’s diarrhea.
The most important vaccine in travel medicine is classically the influenza vaccine, especially in cruises, says Jelinek. “You have to say that the vaccines are not good, but the answer is not to stop vaccinating, but instead to vaccinate as much as possible, because studies have shown that regular vaccinations provide better protection.” Also in the travel medical consultation always the basic vaccine protection should be checked. “Vaccination is always a good opportunity to check vaccine protection, especially for young adults,” says Jelinek.

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